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General Medicine

Pancreatitis, Chronic

Robert L. Frachtman, MD, FACG and Marni L. Martinez, APRN Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Long-standing and progressive destruction of pancreatic tissue due to persistent inflammation

  • Results in exocrine and/or endocrine insufficiency

  • Major features

    • Pain

    • Malabsorption

    • Diabetes...

DIAGNOSIS

As with acute pancreatitis, symptoms do not always correlate well with objective findings (imaging, amylase/lipase). 

HISTORY

  • Epigastric pain, often radiating to the back

  • Flare-ups may mimic ac...

TREATMENT

MEDICATION

First Line

Analgesics (no consensus on specific drugs or doses) 

  • Tramadol 50 mg q6h PO is commonly used as a first line.

  • Chronic opioid (morphine, fentanyl) therapy may be required in...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Depends on the source of the pain and whether a ductal disruption exists 

DIET

  • Small meals high in protein, ~20 g/day of fat; adjust for diabetes; patients with dec...

REFERENCES

1
Forsmark CE. Management of chronic pancreatitis. Gastroenterology.  2013;144(6):1282.e3–1291.e3. [View Abstract on OvidMedline]
2
Yadav D, Hawes RH, Brand RE, et al; for North American ...

ADDITIONAL READING

  • Bertilsson S, Swärd P, Kalaitzakis E. Factors that affect disease progression after first attack of acute pancreatitis. Clin Gastroenterol Hepatol.  2015;13(9):1662.e3–1669.e3.

  • ...

SEE ALSO

Choledocholithiasis; Lupus Erythematosus, Systemic (SLE); Peptic Ulcer Disease; Substance Use Disorders 

CODES

ICD10

K86.1 Other chronic pancreatitis 
K86.0 Alcohol-induced chronic pancreatitis 

ICD9

577.1 Chronic pancreatitis 

SNOMED

  • 235494005 Chronic pancreatitis (disorder)

  • 235952002 Alcohol-induced chronic p...

CLINICAL PEARLS

  • EUS can help differentiate chronic pancreatitis from pancreatic cancer.

  • Pain management is a central component in managing chronic pancreatitis.

  • Pancreatic enzyme replacement therapy, to...

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Related Images
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FIG. 2.34. Choledocholithiasis. Coronal thick slab MRCP demonstrates distal common bile duct stone (arrow).
FIG. 2.34. Choledocholithiasis. Coronal thick slab MRCP demonstrates distal common bile duct stone (arrow).
FIG. 3.151. Choledocholithiasis. Small stone is present in distal common bile duct (arrow) on axial HASTE image.
FIG. 3.151. Choledocholithiasis. Small stone is present in distal common bile duct (arrow) on axial HASTE image.
Gastric ulcer. The stomach has been opened to reveal a sharply demarcated, deep peptic ulcer on the lesser curvature.
Gastric ulcer. The stomach has been opened to reveal a sharply demarcated, deep peptic ulcer on the lesser curvature.
Duodenal ulcer. A sharply punched-out peptic ulcer of the duodenum is situated immediately below the pylorus.
Duodenal ulcer. A sharply punched-out peptic ulcer of the duodenum is situated immediately below the pylorus.
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is incited by a long ulcer (white arrows) on the lesser curvature. (B) Double pylorus. The true pylorus and the accessory channel along the lesser curvature are separated by a bridge, or septum, that produces the appearance of a discrete lucent filling defect (arrow).
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is i...
Figure 15-14 Perforated peptic ulcer of stomach.
Figure 15-14 Perforated peptic ulcer of stomach.
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is incited by a long ulcer (white arrows) on the lesser curvature. (B) Double pylorus. The true pylorus and the accessory channel along the lesser curvature are separated by a bridge, or septum, that produces the appearance of a discrete lucent filling defect (arrow).
Fig GI 10-10 Peptic ulcer disease. (A) Large incisura (black arrow) simulating a filling defect on the greater curvature. The incisura is i...
Fig GI 12-5 Acute pancreatitis. (A) Complete gastric outlet obstruction. (B) As the acute inflammatory process subsides, some barium passes through the severely spastic and narrowed second portion of the duodenum (arrows).
Fig GI 12-5 Acute pancreatitis. (A) Complete gastric outlet obstruction. (B) As the acute inflammatory process subsides, some barium passes...
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